My husband, daughter and I spent a few days at the coast just getting quiet, reading, drinking coffee, walking and listening. The landscape, it is not especially glamorous or light-filled, but we like it that way. I like the quiet serenity of it.
The subtlety of the colors and layers reminds me to look more deeply.
Not everything has to be bright, or vivid. Not everything needs to move.
I am recovering from my fourth cycle of Xeloda and Taxotere, and I’d like to talk about how things are going. This treatment plan is for a recurrence, a 5 cm tumor that showed up during my annual MRI in March of this year. The goal is to shrink this tumor in order to make it operable, and therefore remove it.
I receive Taxotere every three weeks, and, on the same day as the infusion, begin a two-week cycle of 4000 mg of Xeloda. Four pills in the morning, four at night.
As of today my eyes water constantly. My nose is an incessantly dripping faucet, causing me to wipe, drip, wipe, drip, and because of this I’ve become wary of cooking and paperwork. Restless legs make it difficult to fall asleep, leading to a cycle of fatigue and sleeping until 9 or 10 AM that has thrown my summer for a loop.
So far, I feel fortunate that I haven’t experienced Hand/Foot Syndrome, a common and difficult side effect that causes peeling, itching, and can cause the permanent removal of fingerprints. And so far, I have no neuropathy. Knock wood.
But the fatigue. I’m writing this to share with others in treatment, other survivors – you will know what I mean when I talk about the crash, the far, low tide that comes with waking and feeling as if some deep core of bones and blood has been removed, and all that remains is an easily-toppled monument of skin. You become a heap of unmoving muscle, resolved only to rest. Rest and sleep are what the body orders. Mail opening or reading an email becomes an orbit of language that revolves but does not land – I can’t wrap my head around any cognitively demanding tasks after infusions. Give me TV, give me easy magazines. Youtube cat videos and naps.
I find myself cueing up bingeworthy shows: old episodes of The Office, Handmaid’s Tale, Sherlock Holmes, and soon the latest Orange is the New Black. Some of these I watch at night when my husband and daughter sleep. Others I fall asleep to. Dr. Phil is another favorite. After all my losses, I can at least assure myself that I am not duped by internet Don Juans, or that no one in my family has been kidnapped by a cult.
The fatigue, it comes and goes. It is unpredictable and when it comes it must be honored. This is one of the many lessons of cancer: Listen to your body. It is its own untameable animal that requires tending, and if you listen it will lead you well.
How do you deal with fatigue? What are some ways you pass the time when your body says Stay?
Be always dead in Eurydice – climb, with more singing,
climb with praising, back to the pure relation.
Here, in the failing place, in the exhausted realm,
be a ringing glass that shatters as it rings.
Background (scroll down to skip): Rilke wrote this entire sonnet – the entire, magnificent series of sonnets – to Orpheus, the mythical Greek lyre player who has gone to the underworld (Hades) to get his beloved Eurydice back. On Orpheus’ and Eurydice’s wedding day, Eurydice was bit by a snake and died suddenly. Orpheus was heartbroken, and was given the chance to earn her return to life. In an agreement with both Hades and Persephone, the god and queen of the Underworld, Orpheus leads Eurydice back through the dark, arteried maze of death, but must promise not to look back, must promise to trust that Eurydice follows behind him as he makes his way back to Earth. Sadly, he fails. His doubts bedevil him, and just before re-entering the light of terra firma, he turns and looks, but his last vision is of her fading back into darkness. It is a tragedy that tears Orpheus apart with grief. Orpheus’ lyre remains a constellation in the sky called “Lyra.”
What could this mean?
We, cancer patients and survivors, are in “the exhausted realm.” We’re not dead – of course not – but a part of us has died: our illusion of ongoing health, an old life that has changed, a loss of innocence, a sense of ongoingness. I feel that to heal completely, this grief must be felt, acknowledged, allowed to appear fully in the body and mind, and then let go.
It is this feeling and letting go that is the challenge, no? To trust in it. Thankfully we are not bound to an oath like Orpheus, but faith in a new life, a new outcome, or some future hope comes with the painful price of a broken past. It is a pendulum of dark and light. An offering of night, an opening called “Day.” Rilke, in his wisdom, did not recommend an illumination or mirror; rather his word is a gift of transparency, one to break: “glass.”
And in breaking, in shattering, he tells me, be the full-throated voice of grief singing.
He ends the poem like this:
Be – and know at that time the state of non-being,
the infinite ground of our deepest vibration,
so that you may wholly complete it this one time.
In both the used-up, and the hollow and dumb
recourse of all nature, the un-tellable sum,
joyfully count yourself one, and destroy the number.
I feel myself wanting to be in the process of climbing, like Orpheus, back to the “pure relation” of family, daily life without the dark blanket of mortality clouding it. I want to sing praise songs to my doctors, medicine, coffee. I want, like Rilke tells Orpheus, to be “the infinite ground of our deepest vibration” in order to complete the full circuit of grief and healing.
And to count myself, and you, sister or brother survivor, “one” and to wipe out all comparisons, all statistics, all outcomes, percentages, prognoses, doses, stages and grades, milligrams and pounds, cycles, infusions, lab work, blood counts, tumor markers, weights, scans, needles,
It’s almost always meant well. The asker is curious: you have, after all, been diagnosed with cancer, and you haven’t seen each other in awhile. The asker wants an update. They want to know what’s going on. And so, there’s the initial hello, then the pause:
“How are you? How are you doing?”
Sometimes it’s a text message. Sometimes an email.
“How are you doing?”
And you, bearer of the proliferating morass, standing politely with drink in hand, are expected to answer. You have perhaps just had blood drawn, perhaps your tumor markers are higher (indicating growth), your blood counts are off; or you have finished your most recent infusion, grasp fingers that sting with neuropathy, feel too tired some days to even get mail, are bald, breastless, riddled with grief, adrift at work, scattering bills and papers, forgetful, with eyes watering and home disheveled, lie in bed for hours, just brushing your teeth was a climb to Kilimanjaro; take-out dinner boxes litter the countertops, the diarrhea and nausea fluctuate in a horrid yin/yang, and perhaps your gums bleed, toenails have fallen off —
how are you how are you
And in the movie version, the dream sequence. Flashbacks to a past life. In “The Handmaid’s Tale,” Offred remembers her daughter at the beach. I think of running, my long hair with the car windows down, drinking Coke, summer drives with my little girl, hikes with my husband, raucous laughter over wine, faded glass over a country road somewhere, faded, fading.
how are you
Do you want to say, “Fine”? Do you want to say, “Hanging in?” I do, I do. I want to give a glib answer. I don’t want to remember, don’t want to talk. I am more than this disease, am more than an update, and cannot answer to this kind, albeit temporary concern. It is kinder sometimes to not ask, kinder perhaps to think what the question means.
I have erred in this, have erred in the asking. But now, on the receiving side, I find myself sometimes unwilling to reply.
Because the question can trigger remembering. The question can trigger the kind of response that is interrupted – my friend’s mom had breast cancer, too!- with an anecdote that has no bearing, does not help. Or suddenly help is offered, as is unwanted advice about “alternative” treatments. Pineapple cures. Coffee enemas. Or judgement. Or glazed eyes, a disinterest in the reply.
Better, maybe, to say “How’s it going?” or “How about those Dodgers?” Another way: “I’m here for you, here if you ever want to talk.” Or even, “I don’t know what to say, but I’m here.”
We are all stumbling with how to ask, how to answer. Compassion is a given.
Yet sometimes it’s better not to ask. Sometimes coffee or tea is best. Sometimes a quick “I’m at the store – what do you need?” is manna from heaven. Or sometimes silence and companionship – your presence – are gifts enough.
But I want to add, feel it’s important to add: I always take it with kindness, as it is meant. The intent at the heart of the question is always welcome.
How about you? How do you deal with “How are you?”
“Who can become lost in a narrative,
if all he can think of is the end?”
– Mark Doty, “Lament-Heaven”
And so, with cancer comes the question: What is the new narrative of my life?
How long do I have left?
What is my treatment plan?
Logistics: Do I continue to save? Plan a world trip? Get rid of my old stuff?
Planning, the economic and spiritual foundation of modern American self-efficacy, is the Harley-Cancer-Davidson motorcycle driver that breaks you off, sidecar sidekick, and leaves you in the little rig by the side of the road while he takes off down the two-lane highway of certainty. Putt putt, sputter. Stop.
And here you are, ditched and detached in the Death Valley of all deserts, left to contemplate your options. It’s quiet all right. And there’s no driver for miles. What to do, what to do?
I struggle with this. If we continue the metaphor, with Death Valley and the unmoored, detached passenger, bewildered and shocked at the side of the road, I’m still sitting. Two years later and I’m still sitting, still scratching my head, looking at the map and trying to figure out how to get back home. Do you know what I mean?
It’s kind of tragic. It’s also, at times, patently absurd. And funny. I mean: no hair! And what’s a lopsided gal to do when running? Plenty of room to contemplate.
Many other survivors and friends have come past, offered advice, suggested lovely and some-odd things, and pointed out alternate routes. But I can’t go back. I can’t go back to the home of the Old Body, the Old Life. The new is here. And I’m still working out how to navigate life, work, the process of living with chronic disease. I want to rush it. I want to “make it work,” learn from it, deal, manage, fix – do all the productivity-oriented activities my previous and old life would have deemed necessary in order to overcome any personal obstacle. And in focusing on the corrections and fixes, I wonder if I’m losing some kind of view.
That is, just being, living, fully taking in the transition. The road. The sidecar mishap-tragedy that, like Emily Dickinson, tells it slant. Because even in this, there is a narrative. There is story, there is process, there is some nugget of love and living that wants to find a way.
Here now, it seems to tell me. Look at your body, the earth, even the rocks at the edges. Sit awhile longer and take it all in.
It’s the CT, PET, or MRI. The acronyms don’t matter as much as the fear, because what if? What if there’s a blip, a lighting up, a growth, a recurrence, an expansion, a concern? And what if there isn’t? What then?
(“Clear,” calls the Emergency Medical Technician before shocking the heart.)
Cancer is an abusive lover. I’ve learned not to celebrate too much when things go well, because the trust in a long-term, healthy future is gone. Even if the scans show nothing, trust in the world has failed. The sure sense in an ongoing future has failed. Planning a year or five years ahead with certainty? Failed. This “lover” – cancer – is always lurking, its revenge always a possibility. It hides its power, it lures you into comfort. It charms you back into living. It leads you back into your body, the ease of each day’s choreographies: movements through the front door, work, friends, gestures here and there, family, food.
Oh hello, hair, hello travel plans — let us begin again. Let us pretend with the ease of the healthy-bodied living that we are ever ongoing, that we will not, in our careful financial records and remodeling plans, ever perish. Tahiti? Paris? A mani-pedi scheduled for Friday. Oh, and the workout.
Scans jolt me out of this trance. There is the word we are all trying so hard to avoid: death. Dying. A finite closure, that the body and mind and this life as we know it will end. Will.
And so, I have a scan today. A CT scan to see if this current treatment of Xeloda and Taxotere are working to shrink this recurrence. If the tumor has shrunk, we continue, proceed with later surgery, and keep cancer at bay for awhile longer. I’ll take it.
If it’s not working, then we don’t know. Clinical trials, hope for the best.
It’s a rarer type – 15-20% of breast cancers are triple negative.
It’s more common in African-American and Latina women. Diagnosis and treatment equity are a real need.
It has a “worse prognosis,” but if you are a newly diagnosed TNBC (triple negative breast cancer) sister reading this, know that it is a hotbed of research, and new treatments are coming out all the time. Old statistics are not your friend. There is hope.
It is aggressive and tends to spread/grow more quickly than the other types.
It tends to be higher grade (more quickly and aggressively proliferative) and is also discovered at later stages.
Due to its high recurrence rate, most treatments tend to include chemotherapy. Good news: Chemotherapy tends to work very well for TNBC.
Like all other cancers, it stinks.
What Triple Negative Breast Cancer is Not:
A death sentence.
A slow moving, hormone-receptor positive breast cancer for which targeted treatments like Tamoxifen are available. (Although: some TNBC tumors have slight estrogen-receptor positivity, and so at times TNBC patients are prescribed Tamoxifen.)
In talking about this type of breast cancer in my support group and in the world at large, I often find myself having to place TNBC on a hierarchy of ease-of-treatability types. This is understandable. The world of treatment changes constantly, and clinical trials and subtypes and genomic testing are – happily – complicating and more specifically targeting treatments to every woman’s benefit. Yet: TNBC almost always comes out the worst, is still, in some circles, considered the diagnosis to deliver with a sigh and a pause, and Google/goggle/ogle/oogle aka do not Google will only offer doom. Don’t do it.
So, if you have it, I welcome you with open arms to this most unexpected club. We’re a rarer sort, part of the “danger” side of breast cancer. I think of us as the Austin Powers version: